Medical Claims

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Medical Claims

Your Medical ID Card gives you access to all the medical facilities in the Preferred Provider Network detailed in the “Network Booklet Guide” with direct billing between us and the Medical Provider. Your card details information regarding your healthcare plan together with a list of all essential telephone numbers you may need, so make sure to keep it with you at all times.

General Queries

For any general non-claim related queries or complaints, please contact or visit the your nearest Allianz Customer Service Centre or call us on our hotline 19909

In Case of Emergencies

Seek medical advice immediately in case of an emergency by contacting NEXtCARE 24 Hour Claims Centre, our selected Third Party Administrator and member of the Allianz Group chosen for the provision of claims administration.

  • Call Center:  (+202) 24632300
  • Hotline:          (+202) 19154
  • Fax:                  (+202) 24632303 -24632304

When you call, have your Medical ID Card ready in order to be provided with the most efficient service possible.

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NEXtCARE Network

Use the link below to find hospitals, clinics and diagnostic centers within NEXtCARE service providers.

Download Egypt's network directory from here

NEXtCARE Claims Centre

NextCare doctors and qualified medical advisors are available 24 hours a day, 7 days a week offering you professional guidance and confidential assistance.

E-mail: cs@nextcare.com.eg

Call NEXtCARE for information about:

  • Approved network of doctors and medical facilities
  • Benefits coverage and exclusions
  • Pre-authorisation procedures
  • Reimbursement claim procedures
  • General claim procedures

Emergency Treatment

In case of an emergency, always seek immediate medical care.

Emergencies at Network Hospitals

  • A doctor will attend to you immediately
  • Present your Medical ID card as soon as you can
  • The hospital will contact NEXtCARE to arrange settlement for eligible care

Emergencies at Non-Network Hospitals

  • Contact NEXtCARE at the earliest opportunity prior to discharge
  • Pay your bills and follow the reimbursement procedures
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Outpatient Treatment

For outpatient services, please visit the outpatient clinics at any of the preferred provider hospitals listed in the Preferred Provider Booklet. Each time you seek medical care, your attending doctor will complete a claim form (ASOAP Form) containing all information regarding your medical illness, treatment and eligible costs. It is important to:

  • Ensure that all fields are filled completely.
  • Only sign the form after it is completed. Do not sign blank claim forms or multiple claim forms which can be used fraudulently, misusing your benefits and limits.

In order to receive your required prescription, you will be asked to present the yellow copy to the pharmacy to dispense your medication, the pink copy to the laboratories and the blue copy to the scan centers. You will also need to present your Medical ID card and personal identification.

Inpatient Treatment

All inpatient treatments, surgeries and same day procedures require pre-authorisation from NEXtCARE prior to their undertaking. Contact NextCare for pre-authorisation.  

Pre-authorisation: Certain prescribed services require pre-authorisation from NEXtCARE prior to their delivery ensuring that they are a medical necessity, making them eligible for payment under your healthcare plan and billed according to network prices. All network providers are familiar with services that require pre-authorisation.

Pre-authorisation is required for:

  • All in-patient admissions, surgeries and same day procedures
  • Special investigations such as Endoscopy, CT scan and MRI
  • Some diagnostic tests
  • Certain pharmaceutical prescriptions

Claim Reimbursement Procedures

If you choose to visit a non-network licensed medical facility within your geographical scope as per your benefit schedule, you will be required to pay the bill and file a reimbursement claim for eligible expenses. Please ensure that you follow the mandatory requirements:

  1. Take a copy of the Reimbursement Form.
  2. Bring the Reimbursement Form with you and ask your doctor to complete it.
  3. Pay the bill and request an itemized invoice detailing the cost of each individual service.
  4. For hospitalization and same day procedures, please ask your doctor for a complete medical, surgical report and discharge form.
  5. Sign the declaration on the Reimbursement Form and make sure you include your mobile telephone number and bank account details (if any). Attach all original receipts, invoices and other relevant documents.
  6. Keep a copy of all of the documents for your own records and for checking claim payments.
  7. Deliver all the requested documents to any of the company branches or your sales agent within one month from the date of treatment, and receive your money (if any) within one month.

Additional Information

  • Reimbursement is limited to a maximum of 30 days per prescription.
  • Eligible claims submitted for reimbursement are paid by cheque addressed to the policy holder or transferred to the policy holder’s bank account including claims of dependents.
  • Remember to check your invoices before leaving your provider to ensure that all services mentioned in your bill were conducted.
  • Claims from outside the providers network are subject to a maximum of 80% reimbursement of preferred provider price lists unless in cases of emergency.
  • Dental & Optical claims will be on reimbursement basis only.

  Download the reimbursement form here